Provider Demographics
NPI:1053102913
Name:MOENGA, BRIAN NYABOGA
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:NYABOGA
Last Name:MOENGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4304
Mailing Address - Country:US
Mailing Address - Phone:973-393-8301
Mailing Address - Fax:
Practice Address - Street 1:416 N 22ND ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4304
Practice Address - Country:US
Practice Address - Phone:973-393-8301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA85983601385H00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care